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Bronchioloalveolar carcinoma presenting with meningeal carcinomatosis. Cytologic diagnosis in cerebrospinal fluid
96 presence of a primary pulmonary neoplasm (bronchioloalveolar carcinoma). This case illustrates the importance of the cytologic diagnosis of a clinically unsuspected primary neoplasm. Further, together with three earlier reported cases, it indicates that in young patients, tumor cells shedding into the cerebrospinal fluid can be the first indication of bronchioloalveolar carcinoma. Metastatic Adenocarcinoma of the Lung Complicating Pregnancy. A Case Report. Suda, R., Repke, J.T., Steer, R., Niebyl, J.R. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, U.S.A. J. Reprod. Med. 31: 1113-1116, 1986. A case of large cell undifferentiated adenocarcinoma of the lung was complicated by an aggressive clinical course and documented placental metastases. The management of these neoplasms is complex, requiring one to pay attention to the maternal, as well as fetal neonatal, prognosis. Bronchial Mucoepidermoid Carcinoma Metastatic to Skin. Report of a Case and Review of the Literature. Metcalf, J.S., Maize, J.C., Shaw, E.B. Department of Pathology, Medical University of South Carolina, Charleston, SC 29425, U.S.A. Cancer 58: 2556-2559, 1986. A case of bronchial mucoepidermoid carcinoma is reported, the presentation of which was as cutaneous metastases. Histologic, histochemical, and ultrastructural features of the neoplasm are described, and the literature pertaining to bronchial mucoepidermoid carcinoma is reviewed. This case illustrates the potential for aggressive behavior in a mucoepidermoid neoplasm, the histologic features of which are considered low grade by some authors. Because such metastatic lesions my be morphologically identical to tumors that have been described as primary cutaneous mucoepidermoid carcinomas, this differential must be considered by the histopathologist confronted by such a neoplasm. Outcome of Lung Cancer Patients Requiring Mechanical Ventilation for Pulmonary Failure. Ewer, M.S., All, M.K., Atta, M.S. et al. Cardiopulmonary Section, Division of Medicine, University of Texas M.D. Anderson Hospital, Houston, TX 77030, U.S.A. J. Am. Med. Assoc. 256: 3364-3366, 1986. The prognosis of lung cancer patients who are not candidates for surgery is usually poor. The unfavorable natural history of respiratory failure in this group of patients has been suggested as a causative factor. We analyzed the outcome of 46 consecutive patients with primary lung cancer on whom mechanical yen-
tilators were utilized. Although seven patients were ultimately weaned and survived for at least 24 hours, three of them subsequently died prior to discharge from the hospital. The remaining 39 patients died while using the ventilator. Patient age, tumor cell type, and the etiology of respiratory failure were not significantly different between the weaned and unweaned populations. A difference was noted in the duration of mechanical ventilation: none of the patients who could be weaned required mechanical ventilation for more than six days (range, two to six days). Respiratory failure in the nonsurgical lung cancer patient carriers a poor prognosis, and selection of patients for mechanical ventilation should be conservative.
6. SURGERY Postoperative Recurrence of Lung Cancer: Detection by Whole-Body Gallium Scintigraphy. Hatfield, M.K., MacMahon, H., Ryan, J.W. et al. Department of Radiology, University of Chicago, Chicago, IL 60637, U.S.A. Am. J. Roentgenol. 147: 911-916, 1986. The records were reviewed of iii consecutive patients who had lung cancer resected and who were followed with serial postoperative whole-body gallium scans. Scans were obtained preoperatively at intervals of 3-6 months for about 1 year after surgery and subsequently at yearly intervals. The period of follow-up varied from 1.5 to 8 years. Of 55 patients who developed tumor recurrence, a gallium scan was the first indicator of recurrence in ii (20%) and was judged helpful in confirming or localizing a recurrence in another 14 patients (25%). False-positive rates were determined from 175 postoperative scans in the other 56 patients who did not suffer recurrence. Of these 175 scans, 15 (9%) demonstrated abnormalities that were sufficiently suspicious that an additional diagnostic procedure, other than chest radiography, was performed for clarification. However, in no case did the gallium scan result adversely affect the management of the patient. Our data demonstrate that routine postoperative whole-body gallium scanning can facilitate early detection of recurrence in some cases. Judicious use of gallium scanning in cases with clinically suspected recurrence can enable prompt localization, diagnosis, and treatment of recurrent tumor. Long-Term Clinical and Functional Results of Sleeve Lobectomy for Primary Lung Cancer. Deslauriers, J., Gaulin, P., Beaulieu, M. et al. Division of Thoracic Surgery, Hopital Laval, Ste-Foy, Que, Canada. J.
tilators were utilized. Although seven patients were ultimately weaned and survived for at least 24 hours, three of them subsequently died prior to discharge from the hospital. The remaining 39 patients died while using the ventilator. Patient age, tumor cell type, and the etiology of respiratory failure were not significantly different between the weaned and unweaned populations. A difference was noted in the duration of mechanical ventilation: none of the patients who could be weaned required mechanical ventilation for more than six days (range, two to six days). Respiratory failure in the nonsurgical lung cancer patient carriers a poor prognosis, and selection of patients for mechanical ventilation should be conservative.
6. SURGERY Postoperative Recurrence of Lung Cancer: Detection by Whole-Body Gallium Scintigraphy. Hatfield, M.K., MacMahon, H., Ryan, J.W. et al. Department of Radiology, University of Chicago, Chicago, IL 60637, U.S.A. Am. J. Roentgenol. 147: 911-916, 1986. The records were reviewed of iii consecutive patients who had lung cancer resected and who were followed with serial postoperative whole-body gallium scans. Scans were obtained preoperatively at intervals of 3-6 months for about 1 year after surgery and subsequently at yearly intervals. The period of follow-up varied from 1.5 to 8 years. Of 55 patients who developed tumor recurrence, a gallium scan was the first indicator of recurrence in ii (20%) and was judged helpful in confirming or localizing a recurrence in another 14 patients (25%). False-positive rates were determined from 175 postoperative scans in the other 56 patients who did not suffer recurrence. Of these 175 scans, 15 (9%) demonstrated abnormalities that were sufficiently suspicious that an additional diagnostic procedure, other than chest radiography, was performed for clarification. However, in no case did the gallium scan result adversely affect the management of the patient. Our data demonstrate that routine postoperative whole-body gallium scanning can facilitate early detection of recurrence in some cases. Judicious use of gallium scanning in cases with clinically suspected recurrence can enable prompt localization, diagnosis, and treatment of recurrent tumor. Long-Term Clinical and Functional Results of Sleeve Lobectomy for Primary Lung Cancer. Deslauriers, J., Gaulin, P., Beaulieu, M. et al. Division of Thoracic Surgery, Hopital Laval, Ste-Foy, Que, Canada. J.